Samar M. Fawzy

Systemic sclerosis: an ultrasonographic study of skin and subcutaneous tissue in relation to clinical findings

Skin thickening and tightness are characteristic manifestations of systemic sclerosis (SSc) and the only major diagnostic criterion. The aim of this study is to compare the results of high frequency ultrasound of skin and subcutaneous tissue (SC) in SSc patients and healthy control subjects and also to correlate our patients’ US findings with the severity score and with different clinical parameters.

Evidence of association of interleukin-23 receptor gene polymorphisms with Egyptian rheumatoid arthritis patients.

BACKGROUND The identification of additional genetic risk factor is an on-going process that will aid in the understanding of rheumatoid arthritis (RA) aetiology. A genome-wide association scan in Crohns (CD) disease highlighted the interleukin-23 receptor (IL23R) gene as a susceptibility factor. Since the IL-23/IL-17 pathway is known to associate with other autoimmune disease, including rheumatoid arthritis and systemic sclerosis, we hypothesised that IL23R could be a shared susceptibility gene. The rare allele of IL23R single nucleotide polymorphism (SNP) rs11209026 (Arg381Gln) confers strong protection against CD. Our aim was to analyse IL23R SNP (rs11209026, rs2201841, and rs10889677) and to detect its association with RA in Egyptian patients. METHODS A group of Egyptian patients with RA (n=120) and apparently healthy persons as controls (n=120) was genotyped for rs11209026, rs2201841 and rs10889677 by real time/polymerase chain reaction (real-time/PCR) for the first SNP and restriction fragment length polymorphism/PCR (RFLP/PCR) in the last two SNPs. RESULTS Our data emphasise that the AA genotype of rs11209026 (Arg381Gln) was significantly associated with RA patients compared to the controls (P value=0.001).We did not find any significant association between either rs2201841 or rs10889677 and the development of rheumatoid arthritis (P value=1.000 & 0.562 respectively). CONCLUSION Our results suggest that IL23 receptor AA genotype variant of rs11209026 would contribute to RA aetiology; consequently, it might be a genetic marker for RA. We need to address the subgroup of patients who will benefit from the selective suppression of the IL23 signalling which would represent new perspectives toward a personalized therapy of RA patients by further studies.

Asymptomatic celiac sprue in juvenile rheumatic diseases children

Background:  Celiac disease (CD) is the most frequent enteropathy in adults and its coexistence with other autoimmune diseases is frequent.

Difference between early versus delayed postoperative physical rehabilitation protocol following arthroscopic rotator cuff repair

Background Early passive motion exercise has been the standard rehabilitation protocol following rotator cuff repair. However, recent research studies show that longer immobilization may enhance tendon healing. Aim The aim of this study was to compare early passive range of motion (ROM) exercise with a delayed rehabilitation protocol with regard to the effectiveness of stiffness reduction and functional improvements and rates of tendon healing in patients undergoing arthroscopic repair for torn rotator cuffs. Patients and methods This study was performed on 164 patients having a full-thickness tear of the supraspinatus muscle that was repaired using the arthroscopic single-row suture anchor technique along with subacromial decompression. The patients were divided into two groups, early (group 1) and delayed ROM (group 2). In group 1, 78 patients were started on passive elevation and rotation exercises on the second day after surgery. In group 2, 86 patients had their shoulder immobilized for 6 weeks, after which passive motion exercise was started. Patients were followed-up clinically for a minimum of 12 months, and rotator cuff healing was assessed using MRI. Results Both groups had a statistically significant difference between preoperative and postoperative results. As regards American Shoulder and Elbow Surgeon scores, the early group improved from 45.4 preoperatively to 90.9 postoperatively (P<0.0001) and the delayed group improved from 44.59 preoperatively to 91.6 postoperatively (P<0.0001). As regards Constant score, the early group improved from 35.7 preoperatively to 86.5 postoperatively (P<0.0001) and the delayed group improved from 37.8 preoperatively to 88.1 postoperatively (P<0.0001). However, there were no statistically significant differences in rotator cuff healing between the two groups. The follow-up mean of visual analog scale was significantly better in group 2 compared with group 1 at 6 weeks postoperatively but no difference was found after 3 months. In contrast, ROM was better in group 1 compared with group 2 at 6 months postoperatively but no difference was found after 1 year. Conclusion Significant improvement in pain, ROM, and function after arthroscopic rotator cuff repair was seen at 1 year postoperatively, regardless of early or delayed postoperative rehabilitation protocols. However, early motion increases pain scores and may increase the possibility of rotator cuff retear but with early regain of ROM. A delayed rehabilitation protocol with immobilization for 6 weeks would be better for tendon healing without risk for retear or joint stiffness and easily convalescence with less postoperative pain.